Magnetic resonance imaging of carotid plaques: current status and clinical perspectives

Mohamed Kassem, Alexandru Florea, Felix M. Mottaghy, Robert van Oostenbrugge, M. Eline Kooi*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

13 Citations (Web of Science)

Abstract

Rupture of a vulnerable carotid plaque is one of the leading causes of stroke. Carotid magnetic resonance imaging (MRI) is able to visualize all the main hallmarks of plaque vulnerability. Various MRI sequences have been developed in the last two decades to quantify carotid plaque burden and composition. Often, a combination of multiple sequences is used. These MRI techniques have been extensively validated with histological analysis of carotid endarterectomy specimens. High agreement between the MRI and histological measures of plaque burden, intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC) status, inflammation and neovascularization has been demonstrated. Novel MRI sequences allow to generate three-dimensional isotropic images with a large longitudinal coverage. Other new sequences can acquire multiple contrasts using a single sequence leading to a tremendous reduction in scan time. IPH can be easily identified as a hyperintense signal in the bulk of the plaque on strongly T-1-weighted images, such as magnetization-prepared rapid acquisition gradient echo images, acquired within a few minutes with a standard neurovascular coil. Carotid MRI can also be used to evaluate treatment effects. Several meta-analyses have demonstrated a strong predictive value of IPH, LRNC, thinning or rupture of the FC for ischemic cerebrovascular events. Recently, in a large meta-analysis based on individual patient data of asymptomatic and symptomatic individuals with carotid artery stenosis, it was shown that IPH on MRI is an independent risk predictor for stroke, stronger than any known clinical risk parameter. Expert recommendations on carotid plaque MRI protocols have recently been described in a white paper. The present review provides an overview of the current status and applications of carotid plaque MR imaging and its future potential in daily clinical practice.

Original languageEnglish
Article number1266
Number of pages16
JournalAnnals of translational medicine
Volume8
Issue number19
DOIs
Publication statusPublished - Oct 2020

Keywords

  • Atherosclerosis
  • stroke
  • carotid artery
  • magnetic resonance imaging (MRI)
  • RICH NECROTIC CORE
  • ULTRASMALL SUPERPARAMAGNETIC PARTICLES
  • SIMULTANEOUS NONCONTRAST ANGIOGRAPHY
  • ISCHEMIC CEREBROVASCULAR EVENTS
  • HUMAN ATHEROSCLEROTIC PLAQUES
  • IN-VIVO ACCURACY
  • INTRAPLAQUE HEMORRHAGE
  • HIGH-RESOLUTION
  • FIBROUS CAP
  • SYMPTOMATIC PATIENTS

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